What is the best treatment primary hyperparathyroidism but negative preoperative localization studies?
- Surgery! Patient age < 50 years warrants parathyroidectomy. Remember, failure to localize an abnormal parathyroid on imaging has nothing to do with whether or not a patient has HPT or whether or not the patient should undergo surgery.
- The sensitivity of preoperative localization studies is not perfect, and they fail to localize an abnormal parathyroid approximately 15% of the time. Although multiglandular disease is more common when preoperative localization studies are negative, most patients with negative localization will still turn out to have a single adenoma as the cause of their HPT.
- The success rate of surgery, if performed by an experienced surgeon, is still high (> 90%–95%) when preoperative localization is negative.
